Laserfiche WebLink
Minnesota Well and Boring <br /> WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. H 2 8 7 8 2 <br /> Coun�y Name W ND BORING SEALING RECORD M���eso�a u��q�e No. � <br /> �� Minnesota Statutes.Chapter 1031 or W-senes No. <br /> ILe.ve blank I not knownl <br /> Township Name Township No Range No 'Section No. Fr:�cnon(sm. �Ig.) Date Sealed Approximate Date Well '� <br /> � ��� �� , �� � �{"y �fi�� or Boring Consiructed <br /> �'' .�+� �4 f f � � <br /> Numencal Sireet Address or Fre Number and Ciry� .. -n. . �tion `/� ' <br /> 3324 Nievarre, YatfG� ���� L`11� SS�� Depth Betore Sealing ��� ft Onginal Depih �`�"� it <br /> Show exact location of well or bonng Sketch map of well or boring Static Water Level Accurate �� <br /> in section grid with'�X��. location.showing property linea -� <br /> N �� , and buildings. ❑Approximate <br /> � <br /> i i i i <br /> -i -�- -i- -i- 1 � <br /> Singie Aquifer ❑MWUaquifer r� ft. � below above land surface � <br /> i i i i �:.�..p � <br /> -'- -�- -L- -�- `4 �',)'f CASING TYPE � <br /> W i i i � E � <br /> i i � � � <br /> -r -�- -r- -r <br /> � i i i � Sleel ❑Plastic ❑Tile ❑Other �� <br /> h mile <br /> _I I I 1_ .A�j � <br /> '_ ___ ___ _ � .: 1 <br /> S - Screen(rom=�� to `��� fl. Open Hole from to Fl. � <br /> �--i mile--►I OBSTRUCTION/DEBRIS/FILL <br /> Obsiruction ❑Debris ❑Fill <br /> PROPERTV OWNER'S NAME -�^-� <br /> CL�.. � .'. �J�,�"�,C L,<,-'.�i - ^ ,. <br /> •7llC' r�b � '`. �A 1/"S '-V � �C• � �/ � ,-' '1 C'. <br /> Type of debris/obsVuction � <br /> Mailing Address if different than property address indicated above. � <br /> Obsiruction/Debris/Fill removed? Yes ❑No <br /> PUMP � <br /> cs <br /> v � <br /> Removed ❑Not Present ❑ Other � <br /> CASING ;� <br /> GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO <br /> FORMATION <br /> Diameter Depth Set in oversize hole? Annular space initially grouted7 <br /> If not known,indicate estima�ed brmation log from nearby well or boring. <br /> Drift O �in.from � to �i2 f� ❑Yes �No ❑Yes ❑No ❑Unknown <br /> in.from to ft. ❑Yes ❑No ❑Yes ❑No ❑Unknown -� <br /> in.from to fL ❑Yes ❑No ❑Yes ❑No ❑Unknown �� <br /> � <br /> � � METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,OR CASING AND BORE HOLE: �.� <br /> , No Annular Space Exisis �� <br /> Annular space grouted with tremie pipe <br /> ❑Casing Perforation/Removal <br /> �in.from to ft. ❑Perforated ❑Fiemoved <br /> in.irom to ft. ❑Perforated ❑Removed �� <br /> C. <br /> yv <br /> Type of perforaror -� <br /> �❑Other <br /> GROUTING MATERIAL � <br /> � <br /> Groutingmaterial {VL-f�.� ��.✓����.Y��from {� to ��fl. yards _�bags �� <br /> ,� <br /> from to ft. yards bags �� <br /> REMARKS,SOURCE OF DATA,DIFFICULTIES IN SEALING <br /> _ from to ft. yards bags <br /> GrOuLeEl 3" w�11 260' Ckx�p <br /> 1� � �= from to ft. yards bags <br /> �,2 3,� l�llt('miC� UNSEALED WELLS AND BORINGS <br /> 2 j� J.�W�� r{¢ & �� lfTritit fllAN4 Other unsealed well or boring on property7 ❑Yes No ��;� <br /> -'—o d..�.�� �..�.Y�. <br /> LICENSED OR REGISTERED CONTRACTOR CERTIFICA ON <br /> This well or boring was sealed in accordance with Minnesota Rules,Chapter 4725.The information contained in this repoA is <br /> , . true to the best of my knowledge. <br /> - 3k� St«ia3.a �1I Urillirig Ca., Inc. 2TJ7� <br /> - ; _ Contractor Busness Name License o�F?egistiation No. <br /> .,. ,,. .. .�� ._ <br /> . -_ . : � . _.�_�`��.,,�,,r''.� .--,�`�.-� y-�q-9,3 <br /> �nze�resentahve Sgnature Date <br /> LOCAL COPY I„� � � � <br /> Name ol Person Sealing Well or Boring <br /> HE-01434-01 <br />